EVENTS

Interesting study on health care and longevity

Harold Meyerson discusses a new report by the National Research Council and the Institute of Medicine that looks at the relationship between health care and longevity for 17 developed countries.

Of the 17 countries measured, the United States placed dead last in life expectancy, even though we lead the planet in the amount we spend on health care (17.6 percent of gross domestic product in 2010 vs. 11.6 percent each for France and Germany). We get radically less bang for the buck than comparable nations.
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Of the 17 nations studied, the United States ranks first in violent deaths, at roughly three times the level of second-ranking Finland and 15 times that of Japan, which ranked last. This list includes violent deaths by all means, not just gunshots, so it’s a pretty fair measure of either different people’s inherent propensity toward violence or the access people have to deadly weapons when they get violent.

But he then points to a seeming anomaly.

But a funny thing happens to Americans’ life expectancy when they age. The U.S. mortality rate is the highest of the 17 nations until Americans hit 50 and the second-highest until they hit 70. Then our mortality ranking precipitously shifts: By the time American seniors hit 80, they have some of the longest life expectancies in the world.

What gives? There are some obvious possible explanations such as that if your young people with a greater propensity to die are gone in larger numbers early in their lives, then those who survive to old age must be either hardier or more fortunate in many ways. But there’s more to it than that.

But the larger part of the answer is that at age 65, Americans enter a health-care system that ceases to be exceptional when compared with the systems in the other 16 nations studied. They leave behind the private provision of medical coverage, forsake the genius of the market and avail themselves of universal medical insurance. For the first time, they are beneficiaries of the same kind of social policy that their counterparts in other lands enjoy. And presto, change-o: Their life expectancy catches up with and eventually surpasses those of the French, Germans, Britons and Canadians.

There is another possible explanation. People who grew up in the television/ couch-potato/ junk food age are generally more obese and less healthy than people who grew up in the 1940s and 1950s. The explanations are not mutually exclusive, of course.

My observations, as a US expatriot, is that the average US resident is far less active and far more obese than the average western European. There are surely stats on this, but my observations have been extensive: I have spent a significant amount of time (more than a month in 2012 alone) in several western European countries, and lots of time in the US. The lifestyle of US residents is car-based, and sidewalks in many areas are completely empty. Some towns have stopped building sidewalks in neighborhoods! In Europe people walk much more, and eat more “real” food.

But I suppose my real point is that the longevity effects described in the post surely have multiple complex causes. We can’t just assume that the health care system is the controlling factor, though I agree that it probably is an important one.

This is true. The ‘walkability’ of US cities is low. Because of zoning for specialized use, many people live far away from shops, restaurants, workplaces, movie theaters and the like, and the lower level of public transport exacerbates the problem. Only in a few major cities like New York can one live without a car.

I lived for 35 years in the US, in rural areas and small cities, without a driver’s licence or car, and it was HARD! Now I live in a nice third-world country where few have cars and public transportation is common. And people walk everywhere.

I’ll add one more possible cause of the observed longevity pattern. Breast cancer, a major cause of death in the US, is many times more common in the US than in Asia, when matched age-cohorts are compared. This is not a genetic effect but an environmental one; Asian immigrants to the US quickly reach the US rate. This could contribute to the greater middle-age mortality in the US compared to rich Asian nations such as Japan. And it suggests that there is something particularly unhealthy about the US lifestyle + environment (broadly construed).

My usually healthy twenty-something son has no (regular) job and no health care. He absolutely refuses to see a doctor – even when he suffered a concussion. Meanwhile, my eighty-something mother, mother-in-law and step father spend their days seeing doctors and downing handfuls of pills. They’ve all been operated on recently. Their health care bills have been in the hundreds of thousands of dollars. They all have chronic conditions and and/or signs of senile dementia. They complain when they have to pay out of pocket for any health care. And they see no reason to believe health care dollars may be better spent on some small amount of care for younger people – especially those shiftless young people who don’t have regular jobs that offer health insurance.

I’d like to be eighty something now. In twenty years, when I’m there, we will not afford the elderly the health care they receive now in this country.

Stories like yours both sadden and infuriate me. It is crazy that we don’t have a universal health care system where people of any age and any employment status can go and see a doctor when they are hurt or sick.

What I don’t understand about those who oppose it just because they are ok is surely they can see that their children or grandchildren may on occasion not have employer-based insurance and yet may need medical care? Can’t they see that that is very likely? Or is it that they simply don’t care?